NUR 555 HESI Final Exam Study Guide
2026 | 85 Practice Questions, Answers &
Rationales with complete solutions -
SNHU.
SECTION 1: CELLULAR PATHOPHYSIOLOGY
Question 1: A patient experiences a "time-out" cell cycle arrest due to DNA damage.
Which tumor suppressor gene is primarily responsible for this arrest at the G1/S
checkpoint?
A) BRCA1
B) APC
C) p53
D) HER2
Answer: C
Rationale: p53 is activated by DNA damage and halts the cell cycle to allow for repair. If
repair fails, p53 initiates apoptosis. Mutations in p53 are found in many human cancers
and this is a critical mechanism for preventing the propagation of damaged DNA .
Question 2: During reperfusion of an ischemic myocardium, the nurse recalls that the
majority of cellular injury is caused by:
A) Intracellular acidosis
, B) ATP depletion
C) Reactive oxygen species (ROS)
D) Hypercalcemia
Answer: C
Rationale: While ischemia causes initial damage, reperfusion injury is primarily driven by
the sudden reintroduction of oxygen, which generates free radicals (ROS) that damage
cell membranes via lipid peroxidation. ROS are a major contributor to ischemia-
reperfusion injury .
Question 3: A pathologist notes the presence of "apple-green birefringence" on a
Congo red stain of a tissue biopsy. This finding is diagnostic of which type of protein
accumulation?
A) Hemosiderin
B) Amyloid
C) Lipofuscin
D) Bilirubin
Answer: B
Rationale: Amyloid deposits have a characteristic apple-green birefringence under
polarized light when stained with Congo red. This is seen in conditions like Alzheimer's
disease, primary amyloidosis, and multiple myeloma. Hemosiderin is visualized with
Prussian blue stain, not Congo red .
Question 4: A pathologist notes that a tissue sample has cells with large,
hyperchromatic nuclei and a high nuclear-to-cytoplasmic ratio. This appearance is
characteristic of:
A) Normal cells
B) Dysplasia
C) Hypertrophy
D) Metaplasia
, Answer: B
Rationale: Dysplasia is characterized by disordered cellular growth with loss of cellular
uniformity and architectural orientation. Hallmarks include nuclear pleomorphism
(variation in size and shape), hyperchromatic nuclei (darkly stained), and an increased
nuclear-to-cytoplasmic ratio. Dysplasia is often a precursor to malignancy .
Question 5: A patient with Duchenne muscular dystrophy has muscle fibers replaced by
adipose and connective tissue. Which cellular adaptation is occurring?
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Atrophy
Answer: D
Rationale: While individual muscle fibers may hypertrophy initially, the net effect of
muscle wasting in Duchenne's is a decrease in cell size (atrophy) due to the lack of
dystrophin, leading to necrosis and replacement by fat and connective tissue. This is a
progressive, irreversible loss of functional muscle tissue .
Question 6: A patient with chronic anemia has a bone marrow biopsy showing an
increased number of red blood cell precursors. This is an example of which cellular
adaptation?
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Anaplasia
Answer: B
Rationale: Hyperplasia is an increase in the number of cells due to increased mitotic
activity. In response to chronic anemia (low oxygen), the bone marrow produces more
, RBC precursors (erythroid hyperplasia). This is a physiologic, reversible adaptation to
increased demand .
Question 7: A biopsy of a chronic skin ulcer shows replacement of normal squamous
epithelium with columnar cells. This change is known as:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Neoplasia
Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another. In chronic irritation (e.g., Barrett's esophagus from GERD or chronic skin ulcers),
squamous epithelium may transform into columnar epithelium as a protective
mechanism. This adaptation can predispose to malignancy if the irritant persists .
Question 8: Which component of the cell produces hydrogen peroxide (H₂O₂) by using
oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction?
A) Lysosomes
B) Peroxisomes
C) Ribosomes
D) Mitochondria
Answer: B
Rationale: Peroxisomes contain oxidative enzymes that use molecular oxygen to
remove hydrogen atoms from substrates, producing hydrogen peroxide (H₂O₂) as a
byproduct. They are particularly abundant in liver and kidney cells where they function
in detoxification and lipid metabolism .
2026 | 85 Practice Questions, Answers &
Rationales with complete solutions -
SNHU.
SECTION 1: CELLULAR PATHOPHYSIOLOGY
Question 1: A patient experiences a "time-out" cell cycle arrest due to DNA damage.
Which tumor suppressor gene is primarily responsible for this arrest at the G1/S
checkpoint?
A) BRCA1
B) APC
C) p53
D) HER2
Answer: C
Rationale: p53 is activated by DNA damage and halts the cell cycle to allow for repair. If
repair fails, p53 initiates apoptosis. Mutations in p53 are found in many human cancers
and this is a critical mechanism for preventing the propagation of damaged DNA .
Question 2: During reperfusion of an ischemic myocardium, the nurse recalls that the
majority of cellular injury is caused by:
A) Intracellular acidosis
, B) ATP depletion
C) Reactive oxygen species (ROS)
D) Hypercalcemia
Answer: C
Rationale: While ischemia causes initial damage, reperfusion injury is primarily driven by
the sudden reintroduction of oxygen, which generates free radicals (ROS) that damage
cell membranes via lipid peroxidation. ROS are a major contributor to ischemia-
reperfusion injury .
Question 3: A pathologist notes the presence of "apple-green birefringence" on a
Congo red stain of a tissue biopsy. This finding is diagnostic of which type of protein
accumulation?
A) Hemosiderin
B) Amyloid
C) Lipofuscin
D) Bilirubin
Answer: B
Rationale: Amyloid deposits have a characteristic apple-green birefringence under
polarized light when stained with Congo red. This is seen in conditions like Alzheimer's
disease, primary amyloidosis, and multiple myeloma. Hemosiderin is visualized with
Prussian blue stain, not Congo red .
Question 4: A pathologist notes that a tissue sample has cells with large,
hyperchromatic nuclei and a high nuclear-to-cytoplasmic ratio. This appearance is
characteristic of:
A) Normal cells
B) Dysplasia
C) Hypertrophy
D) Metaplasia
, Answer: B
Rationale: Dysplasia is characterized by disordered cellular growth with loss of cellular
uniformity and architectural orientation. Hallmarks include nuclear pleomorphism
(variation in size and shape), hyperchromatic nuclei (darkly stained), and an increased
nuclear-to-cytoplasmic ratio. Dysplasia is often a precursor to malignancy .
Question 5: A patient with Duchenne muscular dystrophy has muscle fibers replaced by
adipose and connective tissue. Which cellular adaptation is occurring?
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Atrophy
Answer: D
Rationale: While individual muscle fibers may hypertrophy initially, the net effect of
muscle wasting in Duchenne's is a decrease in cell size (atrophy) due to the lack of
dystrophin, leading to necrosis and replacement by fat and connective tissue. This is a
progressive, irreversible loss of functional muscle tissue .
Question 6: A patient with chronic anemia has a bone marrow biopsy showing an
increased number of red blood cell precursors. This is an example of which cellular
adaptation?
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Anaplasia
Answer: B
Rationale: Hyperplasia is an increase in the number of cells due to increased mitotic
activity. In response to chronic anemia (low oxygen), the bone marrow produces more
, RBC precursors (erythroid hyperplasia). This is a physiologic, reversible adaptation to
increased demand .
Question 7: A biopsy of a chronic skin ulcer shows replacement of normal squamous
epithelium with columnar cells. This change is known as:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Neoplasia
Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another. In chronic irritation (e.g., Barrett's esophagus from GERD or chronic skin ulcers),
squamous epithelium may transform into columnar epithelium as a protective
mechanism. This adaptation can predispose to malignancy if the irritant persists .
Question 8: Which component of the cell produces hydrogen peroxide (H₂O₂) by using
oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction?
A) Lysosomes
B) Peroxisomes
C) Ribosomes
D) Mitochondria
Answer: B
Rationale: Peroxisomes contain oxidative enzymes that use molecular oxygen to
remove hydrogen atoms from substrates, producing hydrogen peroxide (H₂O₂) as a
byproduct. They are particularly abundant in liver and kidney cells where they function
in detoxification and lipid metabolism .
